My pager goes off again, calling me to ER to assess a patient who is short of breath. As I grab her chart to have a look before I go see her , Oh……. wait, this lady was just in last week. For the same thing. Turns out she has a doctor across town, but she prefers to come see us in the ER. And although we have Electronic Medical Records here at the hospital, it only contains what she is able to tell us. Read: what she remembers to tell us.
So I go through the usual battery of questions:
What brings you in today, what medications do you take, what did you take today, and how long has this been going on?
Me: What brings you in today?
Lady: I can’t breathe.
Me: How long have you been feeling short of breath?
Lady: 4 days now.
Me: So, what brings you in …TODAY? You’ve been short of breath for 4 days now….
Lady: Well, I just couldn’t take it any more.
Me: Do you use inhalers or take Albuterol or any inhaled medications?
Lady: Yes, I take them all.
Me: Can you tell me what medications you take, or did you happen to bring them with you? Or do you have a list?
Lady: Here’s a list. But it’s kind of old.
I read her list, and compare it to what I’m looking at on my screen with her chart pulled up. Two very different lists. So I ask her about each one, and she is clueless. Moving on, I listen to her chest. I double -dose her with Albuterol, and try to get more information from her as she breathes in the medicine.
Me: Have you taken any inhalers today?
Me: But you told me you use inhalers; and you’ve been struggling for 4 days. No inhalers at all this morning?
Lady: No, I ran out. I took my Blood Pressure pill and my water pill and my heart pills.
Me: Do you have any family or neighbors that could bring in all your medications? And why are you on heart pills and water pills? [Me fuming now] [To myself] And, why don’t you know the names and dosages of what you are taking and why?
I did some research on this lady and found out her ‘heart pills’ were Beta-Blockers…. a drug that kept her Albuterol from working for her.
Her ‘water pills’ were from an episode of CHF that got out of control because …. people kept throwing Albuterol at her symptoms.
I asked her to kindly come back one day when she felt better and bring me all her medications, in a bag. And also her medical records, tests, X ray results, etc. from her other doctor. She had a clear X ray, and a Blood Gas from 4 years ago that showed her to be a compensated C02 retainer. She also forgot to tell me she was on 1.5 liters of oxygen at home. And she showed me a new drug, prescribed a while back but never used, because she couldn’t figure it out- yep, you guessed it- an Advair Disk-haler. Even with the Beta-blocker meds, the steroid in the Advair might have saved her a few trips to the ER.
We got her spiffed up, and I haven’t seen her for a while. I wonder how many of her ER visits we could have avoided, had she just brought a list of her medications, listed out by what she takes in the AM, afternoon, and PM. And include nebulizers, inhalers and oxygen as drugs. On the back, please list any chronic things you have going on, and any pertinent latest test results.
With this information, we can get you in and out with probably a lot less needles, X rays, and in a lot less time. Or, we can determine that you need to be admitted ASAP. When you can’t breathe, time is everything. Help us help you the fastest way possible!